As an oncologist of three decades, I am still shaken when I hear a patient carries the diagnosis.

I dodged a bullet in 2015 when a large pituitary tumor, likely induced by radiation therapy, turned out not to be a brain cancer.

I am not talking about the usual pituitary tumor; I have had four surgeries for mine.

I was thrilled to see hints that a new approach offers promise in this context.

The innovative approach led to remarkable responses in three individuals with recurrent glioblastoma. Still, all died within about six months.

Glioblastoma Is A Dreadful Cancer

Before we discuss a possible treatment breakthrough, I want to provide some basics about glioblastoma multiforme.

Glioblastoma multiforme (GBM) is a cancer that starts as a growth of cells in the brain or spinal cord. The malignancy grows quickly and can invade and destroy surrounding healthy tissue.

GBM forms from astrocyte cells that support nerves.

Glioblastoma Demographics

Glioblastoma can happen at any age.

However, it tends to occur more often in older adults and more often in men.

Glioblastoma symptoms include headaches that keep getting worse, nausea and vomiting, blurred or double vision, drowsiness, personality change, and seizures.

Glioblastoma Is Lethal

Treatments might slow cancer growth and reduce symptoms.

There’s no cure for glioblastoma multiforme.

Despite treatments such as surgery, radiation therapy, chemotherapy, and electromagnetic field therapy, GBM has a poor prognosis.

While treatment can extend the life of someone with glioblastoma multiforme, there is no cure.

Into the Future: Cancer Management

Cancer treatment used to be all about surgery, chemotherapy, and radiation. But now, a whole new world of treatments is making a huge impact.

One type is targeted therapy. These drugs, like Gleevec and Herceptin, go straight for specific changes in cancer cells and kill them. Loads of people with cancer are benefiting from these treatments.

Then there’s immunotherapy, which boosts your immune system to fight cancer.

Some of these drugs have been incredible at shrinking tumors or even making them vanish in people with advanced cancer. And in some lucky cases, these effects can stick around for years.

You might have heard of immune checkpoint inhibitors, which are already helping lots of people with cancers like melanoma, lung, breast, and bladder cancer.

But there’s also another kind of immunotherapy called CAR T-cell therapy. It’s not as common as the others, but it’s doing amazing things for tough leukemias and lymphomas, often keeping the cancer at bay for a long time.

How CAR T-cell Therapy Works

CAR T-cell therapy, or chimeric antigen receptor T-cell therapy, is a type of immunotherapy that harnesses the power of the body’s immune system to fight cancer.

Here’s how it works:

1. Collection of T-cells: First, doctors collect a type of white blood cell called T-cells from the patient’s blood. T-cells are a crucial part of the immune system for identifying and attacking foreign or abnormal cells, including cancer cells.
2. Genetic Engineering: T-cells are genetically engineered in the laboratory to produce chimeric antigen receptors (CARs) on their surface. These CARs are artificial receptors that empower T-cells to identify and attach to particular proteins, known as antigens, located on the surface of cancer cells.
3. CAR T-cell expansion: The modified T-cells, now equipped with CARs, are multiplied or expanded to create a larger population of CAR T-cells.
4. Infusion into the Patient: The CAR T-cells are introduced into the patient’s bloodstream after expansion. Within the body, these modified CAR T-cells actively search for and specifically attach to cancer cells that exhibit the designated antigen.
5. Attack on Cancer Cells: When a CAR T-cell connects with a cancer cell, it builds a strong immune reaction against the cancer. This reaction can lead to the CAR T-cells directly destroying the cancer cells and calling in other immune cells to help fight against the cancer.
6. Persistence and Memory: Certain CAR T-cells can remain in the body for long, monitoring for any signs of cancer returning. Memory CAR T-cells can also be produced, swiftly reacting if cancer cells reappear.

Overall, CAR T-cell therapy represents a groundbreaking approach to cancer treatment. It leverages the body’s immune system to target and destroy cancer cells specifically.

The Car T-cell approach offers hope for patients with certain types of advanced or treatment-resistant cancers.

Harvard’s New Study

Massachusetts General Hospital researchers recently took a new approach to CAR-T treatment.

MGH researchers engineered CAR-TEAM cells to treat mixed cell populations in tumors.

Collaborating with Mass General neurosurgeons, the team tried the approach in an early (phase 1) clinical trial of patients with recurrent glioblastoma.

Exciting News

Here are the exciting results:

The first three patients in the trial showed dramatic responses within days.

“We were shocked. These results exceeded our expectations,” offered Stephen J. Bagley, MD, MSCE, section chief of neuro-oncology at Penn Medicine.

But did this translate to extraordinary clinical results? In a word, no.

News Headlines Versus Reality

Using a new delivery system and dual-targeting, the novel approach translated to a rapid response.

Let’s look at the clinic outcomes for the four patients:

• Patient #1 maintained tumor regression for 33 days.
• Patient #2 died (not from treatment but from hydrocephalus (for which the patient declined treatment). This patient had two months of stable disease before the hydrocephalus.
• Patient #3 is at seven months of no progression.
• Patient #4 had three months of tumor stability.
• Patients #5 and #6 had one month of stability at the time of the report.

The dual-targeting and a new delivery system produced rapid results.

But There Were Side Effects

All patients had some side effects (neurotoxicity) within 72 hours of treatment.

Moderate side effects included fatigue, skin ulceration, anorexia, lower oxygen levels, muscle weakness, and drops in some blood counts (lymphocytes, a type of white blood cell).

Into the Future

Researchers are looking to enroll 18 patients in a new trial.

They will examine response length and how that affects survival length.
In addition, the researchers will try to understand why CAR-T works better in some patients than others.

The ability to serially pull out spinal fluid allows for rapid analysis of biomarkers.

My Take

I hope this pilot study improves the management of aggressive brain tumors.

If ongoing studies improve outcomes, researchers may consider using the CAR-T cell approach earlier in the disease process.

Targeting multiple cellular targets with local delivery may help us manage other solid tumors.

The post Breakthrough: New Treatment Sparks Remarkable, Swift Reversal of Brain Cancer in Early Clinical Trials appeared first on Medika Life.

It was supposed to be glorious. My son Ty had just gotten into Stanford, my daughter was nationally ascendant in saber fencing, and another daughter was studying in Kyoto, Japan.

I didn’t expect to have a tumor. But few do, right?

“This is the story of a man named Eddie and it starts at the end, with Eddie dying in the sun. It may seem strange to start a story with an ending, but all endings are also beginnings. We just don’t know it at the time.”

— Mitch Albom

The neurosurgeon told me he would not know if the tumor was benign or malignant until we got the final pathology results.

Into the Abyss

When I awakened from the first surgery (inserting cutting tools through my nose), the neurosurgeon indicated that the tumor was too big to remove.

We would go back the next week, using the same surgical approach.

Again, incomplete resection was needed. Fortunately, I am quite cool when it comes to what are stressful events for others.

Finally, I had surgery by opening my skull (an open craniotomy). With better visualization, the doctor got the vast majority of the benign (not cancer) tumor out. We’ll save the rest of the tumor story for another day, perhaps after I get radiation therapy someday.

Here are five takeaway lessons for me.

1. I Chose My Care Team Carefully

Let’s look at how I chose my neurosurgeon.

• Primary care. I checked in with my primary doctor. Often, a primary care clinician is familiar with an expert best suited to handle the specifics of one’s case.
• Insurance. I determined which doctors were “in-network.” Most health plans have negotiated discounted rates in the USA with certain doctors and healthcare centers in your area. You pay less to visit these doctors and facilities. For insurance purposes, we call them “in-network.” By selecting an “in-network” doctor, I avoided a surprise “out-of-network” charge.

• Board certification.
• Logistics. While I was willing to go anywhere in the country, if necessary, to receive optimal treatment, I also knew it would be preferable to be close to home. I wanted to minimize the disruption to my loved ones and still have the New England trait of maximizing value.
• Interview. I had an extensive consultation with my neurosurgeon (and got input from a second one).

2. Ask Questions. Keep Asking.

I am a radiation oncologist; I help people with benign (not cancer) and malignant (cancer) tumors.

I pride myself on being able to sort through clinical literature, determine levels of evidence, and guide patients to make decisions that fit their goals.

Here are some of the questions that I asked:

• What kind of tumor do I have? Fortunately, it was benign, although utterly bizarre, and occurs in only one in 2,000 cases.
• What treatment do you recommend? Why?
• How many patients have you treated with this condition? In my case, the neurosurgeon was a national leader who had recently lectured at Harvard on the surgical approach.
• What side effects are the most common? Will I lose my smell? Vision? What about appearance, including surgical defects and hair loss?
• What follow-up do you recommend to know if the surgery worked? It worked relatively well; I had a near-complete resection. I will likely need a five-week course of external beam radiation therapy.
• I know I need surgery. Am I a candidate for minimally invasive surgery? Through my nose? Or eyebrow? Or do you need to crack my skull open and have a better view of the tumor?
• Am I a candidate for any clinical trials?

3. I Put Myself at a Distance

Is it possible to study a bird so closely, to observe and catalog its peculiarities in such minute detail that it becomes invisible? Is it possible that we lose sight of its poetry while fastidiously calibrating the span of its wings or the length of its tarsus? That is our pedestrian descriptions of a marbled or vermiculated plumage; we forfeit a glimpse of living canvases, cascades of carefully toned browns and golds that would shame Kandinsky, misty explosions of color to rival Monet? I believe that we do. In approaching our subject with the sensibilities of statisticians and dissections, we distance ourselves increasingly from the marvelous and spell-binding planet of the imagination whose gravity drew us to our studies in the first place.

— “Blood from the shoulder of Pallas.” Watchmen #7.

I was named a top doctor in Seattle area magazines this week, Seattle Magazine and Seattle Met magazine. This is not meant to be a boast. Indeed, few folks care about this naming. Correction, my mother in Connecticut cares and joyfully shares the news with friends and family.

But one of the most valuable things I have learned from helping physicians who have been my patients is that they appreciate it most when I assume they know little about my sub-specialty and management.

I followed this line of thinking. Once I did some basic research, I stopped and turned it over to the objective expert.

4. Be Open to New Treatments. But It’s Okay To Say No.

I asked about clinical trials. Clinical trials are research studies testing new ways to manage medical conditions. I wanted to hear more if my involvement would help improve management and outcomes for future patients. Alas, I had no appropriate clinical trial opportunities.

5. Be Open to Help From Others.

Being open to receiving aid from others is difficult for me. I don’t like being a burden to others.

For me, it is a joy to help others. Doing so is good for my physical and psychological well-being. If you are naturally inclined to offer kindness, please reach out to someone in need; the satisfaction you derive from the act is wonderful (and a bit addictive).

The act of giving activates pleasure-related brain centers and causes a release of serotonin, oxytocin, and dopamine. These three hormones contribute to the experience of pleasure.

Brain Imaging Reveals Joys of Giving

A new study found that the brain’s pleasure centers became activated as people decided to donate part of a new stash of…

www.nih.gov

Back to me. I have trouble accepting help. But in this case, my wife Kayoko was taking care of my youngest in our second home. They had moved there to train with US Olympic Women’s Saber coach and legend Ed Korfanty.

Enter my lovely nurse Melissa, who spirited me to the hospital for my neurosurgical procedure. And a shout out to my dietician colleague Theresa, who provided nourishment to help me heal from surgery.

Three surgeries and a near-death experience (the technician reversed the surgical GPS), but that story is for another day. A pituitary tumor is not a “brain tumor,” but mine was certainly not what one thinks of as a usual pituitary tumor. Next up? Radiation therapy (but not yet).

The post Five Lessons I Learned From Having a “Brain” Tumor appeared first on Medika Life.

The symptoms in formerly healthy staff included severity from pain and ringing in the ears to cognitive difficulties and were thought to be energy pulses associated with radiofrequency energy. A National Academies of Science report stated that the symptoms shared common characteristics.

The most common and distinctive features of the initial onset and acute phase of the illness in Havana personnel were the sudden onset of a perceived loud sound, sometimes described as screeching, chirping, clicking, or piercing, a sensation of intense pressure or vibration in the head, and pain in the ear or more diffusely in the head. Studies have found, via neuroimaging, sustained injury to widespread brain neural networks.

Scientists have faced similar questionable physical maladies related to childhood cancer clusters in areas where high-intensity lines have been strung. Although at least one study could not establish a causal link, but (found it ) could be consistent with a small increased risk. Would a “small increased risk” of cancer in their children be acceptable? One has to wonder.

Cell phone radiation, too, has been investigated as a potential cause of brain cancers. Here, also, there is controversy with studies finding increased brain cancer. But one thing is known, and that is that wireless devices heat tissue by exciting its molecules. One area of the nervous system that seems particularly vulnerable are Schwann cells, which form the vital connections along nerve axon cells.

The studies investigated the proximity of the energy sources, near (cell phones) or somewhat distant (laptop computers and other devices). Could this stimulate cancer cell production?

Special note should be made that these devices are constantly producing, receiving and sending radiowaves since they are in continuous contact with cell towers. It doesn’t matter, therefore, if the device is in use or not — it’s still connecting to the network. Could they produce a schwannoma type of cancer that can affect even the heart, although this is rare?

Super-fast connectivity has brought 5G networks to the fore and herein lies yet another environmental health concern. The battle, understandably, will grow fierce since billions of dollars are being invested, and there is a constant clamor and need for better cell service. Our nation and that of others are inextricably tethered to cell and internet service for vital operations.

Recent actions by a nurse in Massachusetts and investigations by ProPublica have revealed a concerning relationship between the FCC and wireless companies. According to the article, while the FCC has the power to regulate the distribution and assembling of cell towers, it has no power to control the health hazard these towers may pose. Nor does the FCC have the capacity to make health decisions based on their own or the cell companies’ research since it may present apparent conflicts of interest.

The article further states that, In 2018, a massive, nearly-two-decade study by the National Toxicology Program, part of the National Institutes of Health, found “clear evidence” that cellphone radiation caused cancer in lab animals.

As street-side cell towers begin to pop up all over major cities, will we see an increase in radio wave-related disorders, or will they be improperly diagnosed as something else?

The future is murky, and healthcare officials must be vigilant to consider this new threat to health when evaluating patients with the complaints outlined in recent research.

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